Executive Summary

One of the main players in the Indian Health Insurance Sector had reached critical mass. In 2011, the company’s management recognised the need for a comprehensive Business Intelligence System. The goals were to increase market share, reduce policy cancellations, reduce costs, enhance risk management, ensure 100% regulatory compliance and improve claims and settlements.

Facts

  • As per the IRDA Annual Report for 2010-11, apart from Govt. schemes, only a small section of approximately 2.45% of the total population of the country is covered by Health Insurance
  • The Health Insurance industry in India is one of the fastest growing segments with an annual growth rate of 20% for the next 5 years
  • Most Insurance companies in India have Influence over the healthcare delivery mechanism with a sub-optimal delivery network and reduced bargaining power
  • Insufficient data on consumers & disease patterns coupled with the absence of standardised healthcare costs have resulted in under-pricing insurance products, higher value claims, significant levels of fraud and limited product & pricing innovation
  • • Low level of awareness among consumers regarding health insurance products and their benefits increases difficulties in customer acquisition Insufficient data on consumers & disease patterns and limited control of healthcare delivery network resulting in limited product and pricing innovation.

The iCAST Business Intelligence Solution for Insurance Companies

The Insurance company carried out a thorough survey of all BI products available for the Insurance sector and decided on iCAST for their entire operations.  Their survey demonstrated that only iCAST could provide features that are important to achieving the goals set forth in the agenda for Business Intelligence.  These features are:

  1. Data integration between their Client & Policy Administration, Lead Management, Claims Management, Investments Management, Treasury & Accounting, CRM and Sales Force Automation systems seamlessly without programming due to the federation server and the iCAST Information eXchange Service built on SOA architecture that integrated data in a non-invasive manner to present the consolidated view with the lowest latency in the industry
  2. Pre-defined modules for a) Channel Management, b) Claims Management, c) Underwriting, d) Provider Management, e) Investments Management and Product Portfolio Mangement
  3. Ready to use Insurance KPIs and analytics that reduces implementation effort by half
  4. Hybrid warehousing for handling historical and real time information
  5. Pervasive computing with access given to all levels within the organisation via mobile devices
  6. On demand computing with in memory processing to ensure speed of delivery

iCAST provides a full data warehouse, not just data marts. Currently the Sales & Marketing Modules and the Product Mart are in operation. The Claims module implementation is in progress. iCAST provides pervasive computing with access already available at the Zone and Area Office levels. It is in the process of being extended to the Branch level.

Business Benefits

The advantages the insurance company have gained from iCAST are:

  • A simple and secure browser based solution accessible from inside and outside the walls of the organization
  • Ensures the end-users will see only the data they need to fulfill their roles
  • Delivers actionable information to the enterprise with business intelligence for specific lines of business, divisions, regions, teams and individuals for true corporate performance management
  • Comprehensive, complex functionality in a simple, unified BI solution with the ability to integrate data from enterprise systems and other data sources
  • Immediate market and client visibility including customer attrition and critical business success parameters
  • Up-to-date enterprise reporting with dynamic analytical capability that is critical to make timely market correction and adapt to market changes
  • Smart decisions with knowledge gained from data analysed and converted to information, rather than guess work
  • Powerful analytics, slice and dice, ranking, sorting, filtering, dashboards, scorecards, automated alerts, forecasting, predictive analysis, exception reporting, graphs, charts, and other unique and valuable tools to satisfy every user’s need

iCAST enables users to analyse the Values and Numbers that have business significance by multiple dimensions. For instance, the "SALES" data in the insurance company has been transformed by analysing policy sales by Number and Value. The dimensions for the sales data are:

  • Location where sales are made
  • Time period when Sales were made
  • Products that are sold
  • Channels making sales
  • Customer segmentation: Age, Gender & other properties of the customer

The built-in analytics in iCAST provides many business specific reports like:

  • Compare sales of all products with individual Products
  • Product Category-wise sales
  • Product performance compared chronologically, by month, quarter, half-year, annual and 3 years
  • Sales report by Channel and Location, comparing Current and Previous year data

Most commonly used reports

  1. Sales reports for each Zone, Area and Branch with comparative figures for the previous year
  2. Individual Channel-wise business details and Channel details
  3. Cancellation details
  4. Renewal and Fresh Policy Analysis based on Office and Channel
  5. Renewal Retention, Renewal Notice
  6. Office wise Product wise Premium Collected for any period, comparing it with the previous year and Product Category wise Premium Collected for the same period at the respective Offices
  7. Channel Business in the given Period with comparative figures for the same period in the previous year
  8. Details like Utilization Factor and SF Utilization on Active, Inactive and Deactivated sales force for any period with comparative figures for the same period during the previous year
  9. Office-wise Sales Manager-wise Non-Performing Sales Force List
  10. Top and Bottom performer Analysis by Product, Office, Channel (Sales Manager, Agent, Broker, Marketing Trainee and Office Direct)
  11. Product-wise Age-wise Sum analysis of the sum insured with Count of Lives and Cover value
  12. Product-wise Age-wise Sum analysis of the sum insured with Cover code wise Count of Lives and Cover value
  13. Product-wise Occupation-wise Count of Lives and Cover value
  14. Product-wise Gender-wise Count of Lives and Cover value

Claims Management

Effective claims handling paves the way for good customer relationship management. In addition, the insurer has to protect against increasing fraudulent claims. Insurance fraud has become common. A recent study by the Insurance Research Council (IRC) highlighted the fact that almost 40% of the respondents believed that it is acceptable to inflate the claim amount to make up for the premium paid over the years. According to another study by the Insurance Information Institute, fraudulent claims amounted to 10% of the total claims. Most of this additional cost due to fraud is passed on to the consumer in the form of higher premium.

To make a better Claims Management, iCAST Claims Module was implemented. The Incurred Ratio reports, Top performer Reports and Claims Made – Occurrence Period wise reports have been deployed into production.